A new database developed by Amazon Web Services -- Amazon's cloud-computing arm -- aims to facilitate access to data from NIH's 1000 Genomes Project. AWS is incurring the costs of storing the 200 terabytes of data from the genome project.
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Recently published updates by Medical Economics have indicated that money is the prime motivator for physicians adopting EHR systems.
Of the doctors surveyed, 95% indicated that achieving meaningful (and receiving incentive payments) was what drove them to adopt EHR systems. In comparison, improving patient care was listed as a secondary motivation for 53% of doctors.
Let’s be honest with ourselves and admit that money is the reason most of us get out of bed in the morning. And why should health care be any different? The Centers for Medicare & Medicaid Services (CMS) EHR Incentive Programs have already doled out almost $3.8 billion in incentives to eligible professionals (EPs) and hospitals that have demonstrated meaningful use.
According to a report from McKinsey Center for US Health System Reform, the US as a nation spends more on health care than any other nation. As of 2009, the US health care industry generated $2.5 trillion, which is 17.6 % of GDP. And health care spending continues to grow while the rest of the economy is experiencing historically low growth, with outpatient care representing one of the most significant rates of growth. Should we be concerned that our doctors are less concerned with the quality of health than the healthiness of their bottom lines?
How do model-driven health tools improve EHR interoperability?
Imagine if you had a cell phone from a particular carrier that could only call other phones serviced by that carrier. A system such as that would limit the sharing of information and communication among all members in the cell phone community. The current wireless infrastructure allows cell phones to exchange data, text messages, emails, and phone calls across all networks—obviously the best way to facilitate effective communication.
But the same universality doesn’t necessarily exist in the world of health care information technology. A lack of standards and interoperability can create communication and information sharing that is stove-piped, ineffective, duplicative, incomplete—the opposite of the vision of streamlined, effective information sharing that health care information technology (health IT) is meant to facilitate.
The development of the Model-Driven Health Tools (MDHT). MDHT started within the open source, health, and health IT community. The Office of Standards and Interoperability at ONC adopted MDHT into its S&I Framework to create the benchmarks, services, and tools to support standardization.
This initiative establishes a modeling framework and infrastructure to help drive the development of seamless national health IT standards for open communication, model sharing, and standard development within the health and health IT community. The model had to be user-friendly, open to feedback, flexible, and current. MDHT currently has a growing user-based community from the public and private sectors.
Mobile technology. Fifteen years ago, most home computers weren't even linked to the Internet. Today, our computers are both linked and, in many cases, mobile. With more than five billion mobile users worldwide and a massive global network, small mobile devices with significant computing power have become a routine part of day-to-day life for people of all ages. The combination of a smartphone's intuitive interface and thousands of apps for iPhones and Androids aimed at young children has fast made it a child's favorite plaything. And as the smartphone market continues to explode, more parents are passing their phones to their offspring as tools to educate or gadgets to pacify.
Two-thirds of 4- to 7-year-olds have used an iPhone or iPod
6% of 2- to 5-year-olds have their own smartphone
50% of 11 year olds have own cell phone
10% of households with children aged 6-12 have iPads (compared with only 3% of other households);
35% of these households with young children plan to buy some brand of tablet computer in the next year
72% of the 100 top-selling education apps in Apple's iTunes App store this year were aimed at preschoolers and those in elementary school
One of the first products aimed at putting an iPhone into a baby's hands (Fisher-Price's oversize case, providing coverage against drools and tantrums, while doubling as a rattle), rapidly sold out on Amazon; the three apps designed for the case have been downloaded more than 700,000 times
Not very long ago, a patient’s medical chart was considered proprietary information belonging to a doctor or a hospital. But just as technology is remaking the rest of the world, it’s also contributing to remaking the relationship between your doctor and you.
More patients have access to their data now that more doctors are moving to electronic medical records. Emerging technologies are also driving change. People with diabetes might use mobile apps to keep track of blood sugar levels, for example. So, with all this data at a patient’s fingertips, how is the doctor-patient relationship changing?
“Patients, when they come to the doctor seeking health care, aren’t necessarily looking for ‘raw data’ – they have already looked it up online. Instead, they are looking for meaning,” wrote Dr. Robert Rowley recently.
Website-delivered physical activity interventions are successful in producing short-term behavior change. However, problems with engagement and retention of participants in these programs prevent long-term behavior change. New ways of accessing online content (eg, via smartphones) may enhance engagement in these interventions, which in turn may improve the effectiveness of the programs.
Over the study period (90 days), the intervention group logged steps on an average of 62 days, compared with 41 days in the matched group. Intervention participants used the application 71.22% (2210/3103) of the time to log their steps. Logistic regression analyses revealed that use of the application was associated with an increased likelihood to log steps daily during the intervention period compared with those not using the application (odds ratio 3.56, 95% confidence interval 1.72–7.39). Additionally, use of the application was associated with an increased likelihood to log greater than 10,000 steps on each entry (odds ratio 20.64, 95% confidence interval 9.19–46.39). Linear regression analysis revealed a nonsignificant relationship between perceived usability (r = .216, P = .21) and usefulness (r = .229, P = .17) of the application and frequency of logging steps in the intervention group.
Using a smartphone application as an additional delivery method to a website-delivered physical activity intervention may assist in maintaining participant engagement and behavior change. However, due to study design limitations, these outcomes should be interpreted with caution. More research, using larger samples and longer follow-up periods, is needed to replicate the findings of this study.
Having highlighted the critique of a doctor who thinks EHRs should be taking their lead from cutting edge internet technology, it seems appropriate to point to another long-time participant in the EHR world who comes at the issue from a different angle.
Apparently, this commentator has a background in designing EHRs, but in recent years he’s found himself re-thinking his approach.
In part, that’s the result of fielding client complaints. “Typically,” he says, “the biggest complaints are related to altered workflows—usually associated with data entry and EHR-feature navigation.
Repeatedly hearing the same complaints made me wonder how EHR systems might be improved, and reawakened my inner EHR designer.”
To our eyes, the most useful part of his commentary comes in the checklist he provides for the “ideal” EHR. To wit:
“Building an ideal EHR requires solving a set of fundamentally hard problems:
* Building a database that can properly store current and future data elements
Many doctors say they want to spend more time engaging in online activities. But that doesn't reflect their actions in the real world. According to a survey that measured physicians' digital behavior, 84% of doctors would prefer to attend events such as continuing medical education (CME) training online. But only 6.4% say that they actually participate in virtual events very often, and only 18.5% participate in them often.
The Joint Survey of Physician Digital Behavior, conducted by San Francisco-based ON24 and Boston-based MedData Group, queried 971 physicians about their online behavior and use of technology such as the iPad. Among the major findings: 75.5% of the respondents realized that virtual events and webcasts are increasing in number, while 91% asserted that they see benefits to being able to attend more conferences, meetings, and CME events virtually. In addition, 35% of the respondents said that embracing virtual events leads to better overall patient care.
Despite the gap between interest in and adoption of digital technology, some medical professionals assert that virtual events, as well as use of smartphones and tablet PCs, are becoming unavoidable. Dr. Brian Schwartz, a cardiologist with Wellesley Primary Care Medicine in Wellesley, Massachusetts, told InformationWeek Healthcare, "Some of the technology is becoming increasingly mandated, such as the use of electronic records and electronic billing. The way you have to run your practice now is electronic."
Integrating PACS with the electronic health record (EHR) is no easy task, but it's worth the effort to provide clinicians with access to a single, comprehensive view of patient clinical information, according to a team from Harris County Hospital (HCHD) in Houston.
In addition to the clinical benefits of providing clinicians with easy and patient-centered access to images and reports, a PACS-EHR integration project has led to faster turnaround for radiology reports, revenue cycle improvements, and a host of technical improvements for HCHD, the largest public primary healthcare system in Texas.
"To have common access to diagnostic results and images in a way that's easy to get to and is intuitive has really been transformative for our organization," said Dr. John Riggs, medical director of clinical information systems for HCHD.
Below are screen mock-ups based on Facebook’s and Amazon’s user interfaces. Borrowing ideas from them is comfortable because they parallel healthcare processes quite nicely, but also because the user interfaces on today’s EMRs are abominable, and adoption rates are terrible (without financial coercion) as a result. People flock to Facebook and Amazon by the millions, without financial incentives. Why? Because:
Total Value of Software Applications = Functional Value x Usability
Five years ago, the Nintendo Wii was touted as the new "it" thing for improving seniors' health--bowling leagues sprang up in nursing homes, and physical therapists "prescribed" Wii yoga programs to their older patients.
A third of U.S. consumers now use social media sites such as Facebook and Twitter to seek medical information and track and share symptoms. They're also using the sites to vent about doctors, drugs, treatments, medical devices and health plans.
The survey of 1,040 U.S. consumers was put together by consulting firm PricewaterhouseCoopers (PwC) and includes data from a separate survey of healthcare and pharmaceutical executives on how social media is used in their business strategies.
Not unexpectedly, young adults rely on social networks for healthcare information far more than older Americans.
The survey found that more than 80% of those between the ages of 18 and 24 said they're likely to share health information through social media channels -- and nearly 90% said they would trust information found there.
By comparison, less than half (45%) of those surveyed between the ages of 45 and 64 said they're likely to share health information via social media.
This commentary reflects how high-performing healthcare organizations use health information technology to advance patient safety.
Despite increasing awareness of the risks to patients within the US healthcare system and the human and economic toll that medical errors exact, improvements in patient safety have been slow.1,2 While individual accountability for patient outcomes is essential for the delivery of high-quality medical care, the complexity of healthcare requires a highly reliable system built within a culture that recognizes errors and process defects as opportunities to learn and continuously improve. The Institute of Medicine report To Err is Human emphasized the important role of health information technology in preventing harm to patients.3 Through the automation of errorprone tasks and decision support systems designed to minimize reliance on human memory, health information technology has rapidly become an important tool to address problems faced by healthcare organizations and their patient safety programs.
In this essay, we describe the fundamental role of health information technology as a multifaceted and indispensable tool to achieve high reliability in healthcare. We illustrate how health information technology can contribute to the creation of high performance by discussing the operating characteristics of high-performing organizations and how they achieve superior outcomes. Finally, we caution readers that this technology has the potential to disappoint or even harm if poorly designed, implemented, or embedded within an institution that lacks a culture of safety. We write these opinions in our roles as healthcare leaders in an academic medical center that has a well-developed computer physician order entry system and a partially developed electronic medical record.
The patient portal--whose hallmark is direct consumer access to a provider EHR--can build many bridges between physicians and the public they serve.
For a portal to catch on, health care organizations should focus on two key areas, says John Moore, founder of Chilmark Research, which tracks the health I.T. industry. First, says, Moore, the portal needs to be promoted by physicians. “Physicians need to talk it up during the visit as a great way to interact with the practice,” Moore says. Second, the portal needs to give patients access to a handful of transactions and services they find most valuable, Moore says. These include access to lab results, the ability to request appointments, online bill paying and access to their own record. “This is the real basic stuff patients want to do online with physicians,” he says.
Given the fact that it is linked to a particular provider, the portal does have limitations, especially if patients seek services from other specialists, Moore says. “It does not create the full longitudinal record,” he says. Despite that, the portal offers several advantages over stand-alone personal health records, which patients control. “It will be difficult for stand-alone PHRs to make it,” he contends. “They don’t have the most basic tools. They don’t do appointments or refill requests.”
Health systems looking to build a portal have a ripe audience, says Harry Greenspun, M.D., senior advisor, Deloitte Center for Health Solutions. Citing data from Deloitte’s annual health I.T. survey of consumers, Greenspun says that medical associations and community hospitals stand at the top of the heap among consumers as a trusted source for an online health record.
The benefits of mobile in healthcare are obvious. Physicians and nurses can avoid mistakes by knowing more about the patient when they’re asked to make a decision. Doctors can use tablets to educate patients on their conditions and treatment. In many cases the firms start by replacing volume of paper or paper based processes with mobile apps.
Let’s look at the example of RehabCare Group, a 28-year-old provider of therapeutic services based in St Louis. RehabCare is using smartphones and iPads to improve the patient care experience. The company built a custom cloud-based app on top of SalesForece.com to create a paperless patient preadmission and screening process.
Crowd sourcing business models like PatientsLikeMe, 23 and Me and innovation reward models like Innocentive have served as guiding beacons for pharmaceutical corporations looking to access rich data across patient populations. A fair share of companies engage in data licensing strategies to monetize the crowd sourced database. Some like Innocentive offer monetary rewards for competitive solutions. While certain others consider crowdsourcing as an idea pool that is gratis.
Build a Trustworthy Set of References: While boiling the ocean to save the world is a great philanthropic act, it is important for pharma biotechnology companies to ensure that data and solution contributions are at their authentic best. Similar to a host of Open initiatives, specifically those that are focused on knowledge building, the lack of a respectable source could potentially wreck an ambitious drug development program within the organization.
Whose Invention is it Anyway? The biggest dread of all pharmabiologists is the allegiance to inventions. The greatest challenge for your pharmaceutical organization is to ensure the demarcations of Intellectual Property Ownership. With the transition of the life sciences industry into a genetics driven enterprise, the spectre of "Informed Consent" become more important than ever. Hence drafting a strong legal protection against disruptions to your Crowd sourcing business is perhaps more valuable than filing a NME approval.
Separate the Music from the Noise: Large data does not necessarily mean better insight. For instance, given the alarming rate at which the NCBI database is growing, there is little chance that all the data available on cancer genetics and epigenetics is going to lead to much innovation within the next 5 years. Contradictory data points have emerged as a significant challenge for life sciences organizations. This in turn has lead to a massive churn of effort and tools being developed to validate the noise. Unfortunately, the crowd sourcing effort only compounds this problem. The influx of a wide array of ideas centralized towards a specific disease requires that pharma biotechnology organizations invest in a reference repository of past experimentations within their portfolio, to ensure that only the most relevant data is considered.
Thousands of people die needlessly each year in developing countries from oral cancers that could have been detected early with regular dental checkups. But with fewer than one dentist per 100,000 people in many of the world’s rural areas, these checkups are not an option. Now an ultra-low-cost smartphone device being developed at Stanford may enable early diagnosis of these preventable deaths, with no dentist visits required.
Assistant bioengineering professor Manu Prakash, PhD, has developed a way to use smartphones to create detailed images of the oral cavity and screen patients’ mouths for suspicious lesions. The device, which is about the size of a pack of gum, could make it possible for millions of people who live in remote areas to get this imaging done as easily as snapping a photo on a smartphone.
Prakash’s oral cavity scanner, called OScan, consists of a mouth positioner, a circuit board and two rows of fluorescent-light-emitting diodes. It attaches to any smartphone’s built-in camera, and allows an operator — with a quick swipe — to take a high-resolution, panoramic image of a person’s complete mouth cavity. Illuminated by the device’s blue fluorescent light, malignant cancer lesions are easily detected as dark spots.
Images can be sent wirelessly to health workers, dentists or oral surgeons for diagnosis, anywhere in the world. The device is designed for mass production, with an estimated material cost of just a few dollars.
Hospital volunteers foster positive patient relations and do wonders to increase patient and family satisfaction. In this environment of budget cuts, the importance of volunteers is even more evident.
In the chapter, Macduff shares statistics from studies by the Nonprofit Technology Network (NTEN) that help set the stage for using social media in volunteer relations.
Of the sectors where nonprofit organizations operate, 14.5 percent are in health care. Macduff wrote, “It is clear that nonproﬁts and likely their volunteer programs see marketing and fundraising as appropriate uses of social media, but there seems to be timidity about crossing into other areas of usage such as blogs for volunteers to share experiences, Wikis to manage projects or meetings, or a Facebook page only for volunteers.”
Macduff advocates the use of social media to strengthen volunteer programs, and sites NTEN’s 2010 study that reported the reasons nonproﬁts do not use social networking sites: 47 percent say ‘‘lack of expertise,’’ and 32 percent say ‘‘insufficient budget.’’ The last finding, “insufficient budget,” is exactly the reason using social media to strengthen hospital volunteer programs makes so much sense. Social media programs, once implemented, can be run with extreme cost efficiency.
When implementing social media training in other areas of the hospital, include volunteer relations and volunteers themselves. Considering the benefits of increased volunteerism and enhanced patient relations, social media programs directed at volunteers have the potential to have high impact returns.
Healthcare is a highly sophisticated and sensitive industry that requires in-depth support and management. Over the years, the healthcare industry has evolved to bring new technological advancements to its already existing infrastructure.
Managed IT services are becoming an increasingly popular option for many healthcare facilities to further streamline various tasks, such as data management and network monitoring. IT support for the medical industry goes beyond regular services, and it must offer its clients trustworthy options for the proper handling of sensitive information within the healthcare organization.
Recently, big data has been garnering attention as a potential problem-solver for today's industry woes. But, before jumping into the new "data-driven paradigm" of leveraging big data, a recent report by CSC suggests organizations take a look at their basic, data-centered strategy.
"Most organizations have more data to work with than they realize, but they need to recognize the challenges and plan to overcome them," the report reads. "For example, the data landscape is constantly changing. The size, scope, and types of data available are rapidly evolving, and so are the tools needed to make sense of it all. To identify competitive advantages and achieve better command and control over their data, entrepreneurial healthcare executives need to recognize this evolution."
Facilities turn to electronic surveillance to remind health care staff to wash their hands and verify compliance as they push to reduce health care-associated infections.
With patient care and financial stakes higher than ever, the competition is intensifying among companies that offer or are developing high-tech hand hygiene monitoring systems for use in health care facilities.
The Centers for Disease Control and Prevention (CDC) say that clean hands are the single most important factor in preventing the spread of pathogens and antibiotic resistance in health care settings. But, despite efforts to counter the trend, hand hygiene compliance rates remain less than 50 percent, states a report by the Institute for Healthcare Improvement.
The west Orange County nursing home is using Apple iPad 2 tablets to jump-start residents' memory, mobility and social skills that have deteriorated through age, Alzheimer's disease or other types of dementia.
"It came to us as a happy accident," said Judy Skilton, Health Central Park's director. "What started out as one resident's curiosity about … an iPhone turned into something that is helping them spell, track items, make choices and read words. It's amazing."
The iPad's innovative approach with the elderly could open doors to new geriatric and Alzheimer's research as the nation's baby boomers near retirement age and tablets increase in popularity, experts say.
"They are on the cutting edge of technology and geriatric care," said LuMarie Polivka-West, president of Florida Health Care Association, the state's largest advocacy organization for long-term-care providers and the elderly. "We hope to encourage the use of this new technology."
Smartphone apps motivated more than two-thirds of participants in a Stanford University study to exercise more, sit less and improve their diet.